A Simple Way to Reduce the Excess of Antibiotics Prescribed to Kids

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Katherine Harmon Courage is a freelance writer and contributing editor for Scientific American. Her book Octopus! The Most Mysterious Creature In the Sea is out now from Penguin/Current. Follow on Twitter @KHCourage.

Antibiotics have been a boon to modern pediatric medicine—transforming many previously fatal childhood ailments into mere inconveniences. But these revolutionary treatments are not a cure-all. In fact, many common pediatric illnesses, including many ear and respiratory infections, fail to respond to antibiotics. And over-prescription of these meds—especially broad-spectrum antibiotics—is not only costly; it can also contribute to the growing and disconcerting trend of antibiotic resistance and can precipitate further health issues for some children who might have an adverse reaction to the medications.

A total of 174 clinicians from 18 different practices were randomly assigned to either a control group (that was informed that a study was being conducted) or an intervention group that received a short educational session on current pediatric antibiotic prescription guidelines as well as a quarterly report on their individual prescribing stats. The education program focused on pneumonia, sinus infections and strep throat—respiratory infections that often do not require broad-spectrum antibiotics yet are often cited as the reason for prescribing them. The study lasted for a year and covered more than 1.4 million office visits. Prescriptions were tracked via electronic health records.

In the three months before the trial started, about 28 percent of the 185,212 children in the patient population were prescribed antibiotics that the researchers later judged as inappropriate. By the end of the trial, the group of clinicians who received the additional prescription info had cut their erroneous prescription rate in half (to about 14 percent). The largest drop was for pneumonia: initially, antibiotics were prescribed incorrectly in about 16 percent of the cases for pneumonia, but after the intervention, doctors in the education group cut that to just 4 percent.

Inappropriate prescriptions for the three respiratory ailments also declined in the control group during the study period from 33 percent to 24 percent, possibly because they knew they were being included in a study.

“The impact of the intervention group was much better than we thought it would be,” Jeffery Gerber, an assistant professor of pediatrics at Children’s Hospital of Philadelphia and collaborator on the study, said in a prepared statement. “It shows that getting people up to speed and providing simple reminders are helpful. It also shows that you can leverage electronic health records to put together a relatively low-maintenance system to improve prescribing.”

The findings were presented October 18 at IDWeek, a meeting aimed at highlighting progress in the fight against infectious diseases, in San Diego.

“The intervention isn’t complicated or high-tech, so it should be scalable to large populations, where it could make a big difference in slowing resistance and preventing the complications of inappropriate antibiotic use,” Daniel Diekema, director of the Division of Infectious Diseases at the University of Iowa, who was not involved in the new research, said in a prepared statement.

About the Author: Katherine Harmon Courage is a freelance writer and contributing editor for Scientific American. Her book Octopus! The Most Mysterious Creature In the Sea is out now from Penguin/Current. Follow on Twitter @KHCourage.

To determine an antibiotic which would be effective against the bacterial infection (if it is a bacterial infection?), the doctor should take a swab , sputum specimen , etc. of the infected area and send it to a medical lab for analysis. A microbiologist could determine the causal agent, and a list of antibiotics to which this agent is sensitive to. It would likely take 2 to 3 days to get this information, but it would be invaluable to the practitioner. If the causal agent for the sore throat, chest infection, etc. is a virus there is no need to prescribe an antibiotic. The diagnostic test would eliminate the false and useless prescriptions for antibiotics to which the bacterial pathogen is insensitive to. Besides it would help to get jobs for unemployed microbiology graduates.

What’s disturbing about this is that it’s the medics who need the extra education.
Here in Britain I’ve always assumed – perhaps wrongly – that the problem is caused by ignorant patients asking their doctors for antibiotics for things which antibiotics won’t help, refusing to take no for an answer, and their GPs giving in for a quiet life.
If doctors themselves don’t understand some basic medical science, that’s even more worrying.

We’ve also built up potential problems for ourselves here by ‘outsourcing’ cleaning and cooking in hospitals. Since the ideological triumph in the 1980s of politicians who assume ‘public sector bad, private sector good’, when hospital kitchen staff and cleaners were sacked, private contractors now provide food and do cleaning in most British hopitals.
If medical staff no longer see the cleanliness of the hospital itself or of the food as part of their responsibilities, and don’t wash their hands between patients, is it any wonder if we get increased numbers of patients catching antibiotic-resistant diseases and dying from them?http://en.wikipedia.org/wiki/MRSA

I don’t think it is primary physicians who need education, but the parents of the kids. How many times has an irate father called or showed up at my door because I didn’t give his kid an antibiotic for a viral infection and charged for a visit. An ignorant and brainwashed populace is the major problem in the US.

Giving antibiotics for viral infections has never been right and it will never be right. Just today this guy was arguing why doctors would give antibiotics for a sinus infection and not for the common cold. His argument was based on the myth that all respiratory infections regardless of what they are caused by, can be treated with antibiotics. We all know that this i wrong but the issue looks like it is the lack of education about antibiotics….